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Molina et al. 52 weeks of MANHATTAN study. Guselkumab vs second TNFi after failure 1st TNFi in PsA. MDA 52% vs 33%. Remission/LDA 67% vs 62%. @RheumNow #ACR25 Abstr#2373 https://t.co/qdtOlKLfNU
Richard Conway RichardPAConway ( View Tweet)
Zavada et al. 52 patients. bDMARD therapy improves sexual function at 6 months in r-axSpA. Improvements in function, desire, satisfaction in those with baseline erectile dysfunction @RheumNow #ACR25 Abstr#2346 https://t.co/IUMGCFnXZh
Richard Conway RichardPAConway ( View Tweet)
Konsta et al. Adding NSAID to TNF inhibits spinal but not hip radiograpic progress. 262 patients, TNF+NSAID 100, TNF alone 162. New syndesmophytes 36% vs 58%. ΔmSASSS-score/year 0.1 vs 0.7. No effect on progression of hip radiographs. @RheumNow #ACR25 Abstr#2359 #ACRBest https://t.co/k9j2M2E3ze
Richard Conway RichardPAConway ( View Tweet)
Rotation or Change in Biologic post TNFi failure in axSpA. Switching biologic class after TNFi failure improved outcomes in axial SpA. In a randomized trial of axSpA patients with inadequate response to a first TNFi, switching to an IL-17Ai was not superior to cycling to a second https://t.co/MEsokWeT8e
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Late-Breaking Trials in axSpA and PsA https://t.co/Fw8wiAPLoN
The amazing @Janetbirdope discussing head to head trials in Axial SpA and PsA with primary failure to TNF.
To switch to another TNF or IL17?
IL17 for my PsA patient for sure.
@RheumNow
#ACR25
Nouf Al hemmadi NoufAhmedAlham2 ( View Tweet)
Management of cardiac and joint sarcoidosis. Use of TNFi in treatment refractory cases. Alana Nevares-Berrios @RheumNow #ACR25 https://t.co/hXOfkgQHP9
Links:
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Abstract 1657: Can LLMs track medication history? GPT-4 outperformed most LLMs in identifying TNFi start/stop events and reasons for switch. 💊 Common reasons for TNFi switching: lack of effectiveness, adverse events, and insurance/cost barriers. @RheumNow #ACR25 https://t.co/5FUR9tBoyu
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
TNFi induction first year in RA leads to:
- less D2T RA at 5y
- more sustained remission from 10y onward
- less DMARD utilization
- less healthcare utilization
in these real-world matched cohorts
given biosimilar prices, this might be worth considering
#ACR25 ABST1677 @RheumNow https://t.co/uL9nHtLkXZ
Links:
David Liew drdavidliew ( View Tweet)
Early TNFi treatment leads to
-Less D2T at 5 yrs
-More sustained remission at 10yrs
-Less bDMARD escalation at 5yrs
-More DMARD free remission at 5yrs and 10 yrs
-20% reduction annual healths costs
-11 mo delay in ttmt escalation
Safety data were not presented
#ACR25 https://t.co/jPMGUGPtqP
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Start strong, stay strong.
With early anti-TNF induction (vs csDMARD T2T)
- At 5 yrs: D2T RA in <1% vs 7% (OR 0.11, p=0.03)
Drug-free remission 13% vs 6% (p=0.049)
- At 10 yrs: more sustained remission (62% vs 45%) & fewer multi-MoA failures.
@RheumNow #ACR25 Abstract #1677
Jiha Lee JihaRheum ( View Tweet)
Implantable vagal stimulator led to benefit in TNF-inadequate responder RA in this sham-controlled double-blind RCT (RESET-RA study)
- 82% off b/tsDMARDs at 12mo
- also with benefit to control group after crossover at 3mo to an active device
#ACR25 1675 @RheumNow https://t.co/yYwWCKm6HF
David Liew drdavidliew ( View Tweet)
Beyond biologics: RA meets bioelectric medicine.
In RESET-RA, TNFi inadequate response or intolerant (n=124), vagus nerve stimulation led to significant & durable improvement
🔹 ACR20 3mo: 42% active vs 18% sham (p=0.0057)
🔹 Benefits through 12mo
@RheumNow #ACR25 A#1675
Jiha Lee JihaRheum ( View Tweet)
In pooled analysis of 9 PsA trials, 6.9% of secukinumab-treated patients had fungal infections, mostly mild/moderate. Candida rates were low (1.86–2.18/100 PY) and didn’t increase over time. 89.7% resolved fully; only 0.8% led to discontinuation. Abstract 1459 @RheumNow #ACR25 https://t.co/kltMZVEDf9
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Mease et al. What agent to use after failure of first TNFi in PsA. Real world study, 320 patients. Switching to upadacitinib led to better joint responses than second TNFi or IL17i @RheumNow #ACR25 Abstr#1453 https://t.co/SQnN0skw7r
Richard Conway RichardPAConway ( View Tweet)
Gensler et al. Bimekizumab in male and female axSpA patients. Greater benefit in males at week 16, but similar responses at week 52 @RheumNow #ACR25 Abstr#1449 https://t.co/zDYI2zItqT
Richard Conway RichardPAConway ( View Tweet)
In high-risk psoriasis patients with nail disease, Secukinumab reduced PsA onset over 5 years with a total exposure of 1022 patient-years. Annual incidence dropped from 2.7 to 0.49 per 100 patient-years. Data from the real world SERENA study. Abstract 1463 @RheumNow #ACR25
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
What is better in #PsA post #TNFi?
#RCT of #secukinumab v #ustekinumab
The big 🤔? #IL17Ai vs IL12/23i
🏆 #Cosentyx
✈️✅PASI
⚜️✅ACR50
Will H2H studies change our #prescribing?🤷♀️
#rheums Rx #IL17i>#IL12i/23i vs #derms
#ACRBest #ACR25 @RheumNow @ACRheum abst#LB06 https://t.co/RpC8ymDc7H
Janet Pope Janetbirdope ( View Tweet)
To #cycle within or go to another drug class I #axSpA?
#RCT of #TNFi-IR
👇
2nd #TNFi v #IL17i
#IJDM it doesn’t matter what choice as
#IL17i WAS NOT superior to TNFi cycling from 1st -2nd
👍 stay in #TNFi class = change to #IL17i
#ACR25 @RheumNow abst#LB09
#ACRBest @ACRheum https://t.co/VCdL5CUYUa
Links:
Janet Pope Janetbirdope ( View Tweet)
Effect of BioDMARDs on Diabetes risk in 6400+ Psoriasis pts
IL-23i and IL-17Ai associated w/
-lower risks of diabetes
-Diabetic nephropathy
-Stage 3–5 CKD
and reduced risk compared to TNFi treated and bionaive pts
Adjustment on several variables, but not disease severity https://t.co/TDIHXJOC2T
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
A systematic review by Dr. SRamiro et al evaluated efficacy of b/tsDMARDs on peripheral axSpA
Majority on bDMARDs (TNFi, n=24; IL-17, n=13)
Most of the SMDs were small --> b/tsDMARDs showed small to moderate effects on peripheral arthritis & enthesitis.
#ACR25 @RheumNow Abs0588 https://t.co/yGXcqhZ1Uv
sheila RHEUMarampa ( View Tweet)
